Provider Demographics
NPI:1639296593
Name:PLACENCIA, SABRINA MARIE (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:SABRINA
Middle Name:MARIE
Last Name:PLACENCIA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:PAULDEN
Mailing Address - State:AZ
Mailing Address - Zip Code:86334-0083
Mailing Address - Country:US
Mailing Address - Phone:928-830-8693
Mailing Address - Fax:
Practice Address - Street 1:450 WHITE SPAR RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4626
Practice Address - Country:US
Practice Address - Phone:928-778-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7392183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician